May 2020

In This Issue: Advancements in VA Primary Care
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Using Peer Navigators to Increase Access to VA and Community Resources for Veterans with Diabetes-Related Distress

Feature Article

Takeaway: This Veteran peer-coaching intervention (iNSPiRED) aims to enhance psychological well-being and diabetes self-management behavior among Veterans with diabetes by facilitating access to and use of healthcare and health promotion resources. An important secondary aim is to strengthen and integrate VA partnerships with community-based organizations and Veteran Support Organizations (VSO's).

Diabetes-related distress – the negative emotional impact of living with diabetes – is a powerful predictor of psychosocial functioning, treatment adherence, and glycemic control. Practice guidelines and consensus statements call for innovative approaches to address diabetes-related distress. Despite availability of self- management and psychosocial interventions to reduce diabetes-related distress, these interventions are under-used due to constraints in time, finances, motivation, and resource awareness. Interventions that leverage traditional medical care and community-based health promotion programs (e.g., diabetes self- management education (DSME) programs) may enhance the ability of Veterans with diabetes to engage with a broad and accessible range of resources. Ensuring that Veterans with diabetes receive adequate self-care support requires interventions that attend to both medical care and diabetes-related distress—and improve Veterans' access and engagement with DSME and traditional medical and mental healthcare. Integrating VA and community health services and DSME resources is innovative and affords great opportunities to enhance Veteran outcomes and build VA community partnerships.

This HSR&D funded study (May 2019 – April 2023) consists of a community-VA partnership and three-month Veteran peer-coaching intervention (iNSPiRED) that aims to enhance psychological well-being and diabetes self-management behavior in Veterans with diabetes by facilitating access to and use of healthcare and health promotion resources. The intervention focuses on reducing cognitive and practical barriers to the use of services by engaging Veteran peers as coaches and navigators, and by encouraging engagement in health promotion and healthcare services in VA and the greater community. An important secondary goal is to strengthen and integrate VA partnerships with community-based organizations and Veteran Support Organizations (VSO's).

Methods

Investigators conducting this randomized trial of a three-month peer-navigation intervention will recruit Veterans with diabetes-related distress through existing help-seeking channels within and outside of VA in partnership with community agencies, VSOs, and the Michael E. DeBakey VA Medical Center in Houston, TX. Eligible Veterans will be assigned at random to the iNSPiRED intervention (peer navigation and coaching) versus usual care (written resource materials and encouragement to continue follow-up with healthcare providers).

The primary outcome is diabetes-related distress. Secondary outcomes include anxiety symptoms, depression symptoms, diabetes self-management behaviors, and the self-reported use and new use of VA or community resources. In addition to participant-level outcomes, investigators will evaluate stakeholder outcomes, including the impact of stakeholder engagement activities on the development and sustainability of VA-community partnerships, trust and communication, and capacity building. An assessment of primary and secondary outcomes will occur at baseline, post-intervention, and at six months.

Findings

None at this time.

Anticipated Impact

If this project meets its anticipated goals, investigators will partner with VA’s Office of Community Engagement and VA Specialty Care Services to implement the intervention for diabetes and other chronic diseases that are prevalent among Veterans.

Principal Investigator: Mark Kunik, MD, MPH, Chief, Behavioral Health & Implementation Program, HSR&D’s Center for Innovations in Quality, Effectiveness and Safety (IQuESt) in Houston, TX.

Publications

None at this time.

View study abstract